Provider Demographics
NPI:1871767111
Name:KHAJA ALIUDDIN MD SC
Entity type:Organization
Organization Name:KHAJA ALIUDDIN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-522-1216
Mailing Address - Street 1:3147 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3307
Mailing Address - Country:US
Mailing Address - Phone:773-522-1216
Mailing Address - Fax:773-522-9660
Practice Address - Street 1:3147 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3307
Practice Address - Country:US
Practice Address - Phone:773-522-1216
Practice Address - Fax:773-522-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL751940Medicare PIN
ILC47998Medicare UPIN